When seeing new patients for a consultation, we often hear questions that remind us just how much confusion exists around what a hysterectomy actually involves. Many patients aren’t sure what exactly gets removed during a hysterectomy—and it’s easy to understand why. One common point of confusion is that while periods stop after a hysterectomy, this doesn’t necessarily mean you’ve entered menopause. Menopause only occurs when the ovaries are surgically removed or naturally stop producing hormones. Another source of confusion is terminology: in the medical community, a “total hysterectomy” refers to the removal of the uterus and cervix, but many people outside the medical field use the term to mean removal of the uterus along with the ovaries. In the next few paragraphs, we’ll aim to clear up these terms and explain what we generally recommend should stay—and what should go—when a hysterectomy is performed.

The cervix, which is the lower part of the uterus that connects to the vagina, is removed when a total hysterectomy – as opposed to a supracervical hysterectomy – is performed. When surgery is being performed for conditions like endometriosis or adenomyosis, we strongly recommend removing the cervix. Leaving it in place can lead to persistent pain or bleeding, especially if endometriosis tissue remains. In our experience, removing the cervix improves patient outcomes and reduces the risk of ongoing symptoms.

The fallopian tubes are another structure we recommend removing at the time of hysterectomy. Over the past decade, evidence has emerged suggesting that some types of ovarian cancer may actually originate in the fallopian tubes. Since the tubes no longer serve a purpose once the uterus is removed—they’re normally the path for the egg to travel from the ovary to the uterus—removing them is a proactive step to lower cancer risk, without impacting hormone levels or overall health.

When it comes to the ovaries, we generally recommend preserving them during hysterectomy. The ovaries continue to produce hormones that are important for bone health, brain function, and cardiovascular support—even after menstruation ends. There are exceptions: if a patient has had multiple ovarian cyst surgeries and there’s very little healthy ovarian tissue remaining, or if there’s a strong family history of breast or ovarian cancer, we may discuss removing one or both ovaries. But in most cases, keeping the ovaries allows patients to avoid surgical menopause and maintain their natural hormonal function.

Every patient is unique, and we believe treatment should be tailored to each individual’s history, needs, and health goals. At Pacific Endometriosis and Pelvic Surgery, we make it a priority to talk through all aspects of surgery and ensure our patients fully understand what would be removed and why. Understanding the anatomy and reasoning behind a hysterectomy is just one step in helping you make informed, confident decisions about your care.